<?
require("config.php");
$langname = 'newsletters';
require("header.php");

if(isset($_POST['newsletter']) && !empty($_POST['newsletter']))  {
    $newsletter = $_POST['newsletter'];
} else {
    $newsletter = '';
}

$showNewsletters = true;
?>
<style type="text/css">
<!--
.style1 {color: #FF0000}
-->
</style>
<table width="100%" border="0" align="center" cellpadding="0" cellspacing="0">
  <tr> 
    <td width="186" valign="top"> 
      <?require("nav.php")?>
    </td>
    <td width="11"><img src="images/shim.gif" width="11" height="1"></td>
    <td valign="top"> 
      <?require("menu.php")?>
      <table width="100%" border="0" cellspacing="0" cellpadding="0">
        <tr> 
          <td align="right"><table width="100%" border="0">
              <tr> 
                <td height="50" class="header">&gt;&gt; Subscribe to Our Newsletters </td>
              </tr>
            </table></td>
        </tr>
      </table>
      <table width="100%" border="0" cellspacing="0" cellpadding="5">
        <tr> 
          <td><?php
						
						$q = "select details from med_display_content where code='newsletters'";

$r = myQuery($q);
						
						
						
						require ("bin/country.php");
						
						?>
<?=$r[0][0]?><br /><br />
<script language="JavaScript"> 
<!-- 
function checkForm1() { 

if (validate_email(document.getElementById("Email").value)== false){ 
    document.getElementById("Email").focus(); 
    alert("Invalid E-mail."); 
    return false; } 
if (document.getElementById("FirstName").value=="") { 
    document.getElementById("FirstName").focus(); 
    alert("Please enter your First Name."); 
    return false; } 

if (document.getElementById("LastName").value=="") { 
    document.getElementById("LastName").focus(); 
    alert("Please enter your Family Name."); 
    return false; } 

if (document.getElementById("Address").value=="") { 
    document.getElementById("Address").focus(); 
    alert("Please enter your Address."); 
    return false; } 
if (document.getElementById("Tel").value=="") { 
    document.getElementById("Tel").focus(); 
    alert("Please enter your Tel."); 
    return false; } 

if (document.getElementById("subscript_code").value==""){ 
    document.getElementById("subscript_code").focus(); 
    alert("Please enter the verify code."); 
    return false; } 

	return true;
}

function btnClick()
{
	if(checkForm1())
	{
		document.getElementById("form1").submit();
		//document.getElementById("form1").reset();
		return true;
	}
	else
	{
		return false;
	}
}
function CountryChange(sel,trid)
{
	if(sel.value == "Denmark")
	{
		document.getElementById(trid).style.display="none";
		document.getElementById("State").value="";
	}
	else
	{
		document.getElementById(trid).style.display="";
		document.getElementById("State").value="";
	}
}
//--> 
</script>				
<table name="nl1" width="100%" border="0" height="60">
<form action="subscribe.php" method="post" id="form1" name="form1" target="_blank">
        <tr>
          <td class="tdheader"><font color="red">* </font>Email :</td>
          <td><input type="text" class="text" id="Email" name="Email" size="40" value="<? echo $newsletter;?>" /></td>
        </tr>
        <tr>
          <td class="tdheader"><font color="red">* </font>First Name :</td>
          <td><input name="FirstName" type="text" class="text" id="FirstName" size="40" /></td>
        </tr>
        <tr>
          <td class="tdheader"><font color="red">* </font>Last Name :</td>
          <td><input name="LastName" type="text" class="text" id="LastName" size="40" /></td>
        </tr>
        <tr>
          <td class="tdheader">Company :</td>
          <td> <input id="Company" name="Company" type="text" class="text"  size="40"> </td>
        </tr>
        <tr>
          <td class="tdheader">Branch :</td>
          <td><input id="branch" name="Branch" type="text" class="text"  size="40"></td>
        </tr>
        <tr>
          <td class="tdheader">Profession :</td>
          <td><input name="Profession" type="text" class="text" id="Profession" size="40" /></td>
        </tr>
        <tr>
          <td class="tdheader"><font color="red">*</font>Company Address :</td>
          <td><input name="Address" type="text" class="text" id="Address" size="40" /></td>
        </tr>
          <tr>
            <td class="tdheader">Zip :</td>
            <td><input type="text" id="Zip" name="Zip" size="40" class="text" /></td>
          </tr>
          <tr>
            <td><span class="tdheader">City :</span></td>
            <td><input name="City" id="City" type="text" class="text"size="40" /></td>
          </tr>
		  <tr id="trState" style="display:none">
            <td class="tdheader">State :</td>
            <td><input id="State" name="State" type="text" class="text"  size="40" /></td>
          </tr>
          <tr>
          <td class="tdheader">Country :</td>
          <td><?print(FFPCountry("Denmark", "Country","CountryChange(this,'trState');"))?></td>
        </tr>
        <tr>
          <td class="tdheader"><font color="red">* </font>Tel :</td>
          <td><input name="Tel" type="text" class="text" id="Tel" size="40" /></td>
        </tr>
        <tr>
          <td class="tdheader">Mobile :</td>
          <td><input name="Mobile" type="text" class="text" id="Mobile" size="40" /></td>
        </tr>
        <tr>
          <td class="tdheader">Language :</td>
          <td>
            <input name="lang_english" type="checkbox" id="lang_english" value="checked" <?print($active2)?> />
            English <br />
            <input name="lang_dannish" type="checkbox" id="lang_dannish" value="checked" <?print($active3)?> />
            Danish <br />
            <input name="lang_chinese" type="checkbox" id="lang_chinese" value="checked" <?print($active4)?> />
            Chinese </td>
        </tr>
        
        <tr>
          <td><span class="tdheader"><span class="style1">* </span>Verify  Code</span></td>
          <td height="20"><input name="subscript_code" type="text" class="text" id="subscript_code" size="10" />
            <img src="authimg.php?type=4" border="0" /></td>
        </tr>
        <tr>
          <td width="20%">&nbsp;</td> 
          <td width="80%" height="20"><input name="Submit" type="image" value="Submit" src="images/bt_subscribe.gif" border="0" onclick="return btnClick();">
            <input type="hidden" name="action" value="add" /></td>
        </tr>
		<!--
        <tr>
          <td><a href="<?=$rela_path?>newsletters.php">see past newsletters</a></td>
        </tr>
		-->
		</form>
      </table>
          </td>
        </tr>
        <tr> 
          <td><a href="newsletters_archives.php"><br />
          Archives of Our Newsletters</a></td>
        </tr>
        <tr> 
          <td valign="top"><p> <br>
            </p></td>
        </tr>
      </table>
      <br> <br> <br>
      <br> </td>
    <td width="11"><img src="images/shim.gif" width="11" height="1"></td>
    <td width="173" valign="top">
	
	
<?require("list.php")?>	 
	  
	  
    </td>

  </tr>
</table>





<?require("footer.php")?>	